Advertisement

Multiple Myeloma

  • Mario A. Dicato
Chapter

Abstract

The treatment and prognosis of multiple myeloma have completely changed over the past years with the advent of the new non-chemotherapeutic agents like imids and proteasome inhibitors followed by their second generations and other new drugs. Their side effects are completely different from those seen with standard chemotherapeutic treatment. Some are common, like peripheral neuropathy, blood count changes, venous thromboembolic events, fatigue, and others. These different toxicity profiles allow combinations and sequences of administration, trying to avoid cumulative toxicities and increasing the treatment combinations. In the first edition of this book there were only three but important drugs. Just a few years down the road in this second edition, our armamentarium has enlarged to additional imids and proteasome inhibitors, as well as completely new drugs, being monoclonal antibodies and HDAC inhibitors, and certainly more to come including immuno-oncology drugs. Over the next few years on some of the new drugs, now used in relapsed/refractory myeloma, data will become available also in induction and maintenance therapy. It is highly probable that the explosion of indications of immuno-oncology treatments will include also multiple myeloma. The transformation two decades ago of this lethal disease into a chronic disorder is being further improved and confirmed more and more.

Keywords

Myeloma Plasma cell dyscrasias Side effects Thalidomide Lenalidomide Pomalidomide Bortezomib Carfilzomib Ixazomib Daratumumab Elotuzumab 

References

  1. 1.
    Mateos MV. Management of treatment related adverse events in patients with multiple myeloma. Cancer Treat Rev. 2010;36(Suppl 2):S24–32. http://www.ncbi.nim.nih.gov/pubmed/20472185 CrossRefPubMedGoogle Scholar
  2. 2.
    FDA. US thalidomide label 1–28, NDA 020785, Accessed 5. 2017.Google Scholar
  3. 3.
    Attal M, Lauwers VC, Marit G, Caillot D, Facon T, Hulin C, et al. Maintenance treatment with lenalidomide after transplantation for myeloma: final analysis of the IMF 2005–02. Blood. 2010;116:310.Google Scholar
  4. 4.
    McCarthy PL, Owzar K, Anderson KC, Hofmeister CC, Hurd DD, Hassoun H, et al. Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous hematopoietic stem cell transplantation for multiple myeloma: CALGB 100104 abstract. Blood. 2010;116:37.Google Scholar
  5. 5.
    Stewart AK, Trudel S, Bahlis N, et al. A randomized phase III trial of thalidomide and prednisone as maintenance therapy following autologous stem cell transplantation in patients with multiple myeloma: the NCIC CTG myeloma 10 trial (abstract). Blood. 2010;116(21):39.Google Scholar
  6. 6.
    Mandala M, Falanga A, Roila F. Management of venous thromboembolism in cancer patients. ESMO Clinical Practice Guidelines. Ann Oncol. 2011;22(Suppl 6):85–92.Google Scholar
  7. 7.
    Palumbo A, Rajkumar SV, Dimopoulos MA, Richardson PG, San Miguel J, Barlogie B, et al. Prevention of thalidomide and lenalidomide associated thrombosis in myeloma. Leukemia. 2008;22:414–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Delforge M, Bladé J, Dimopoulos MA, Facon T, Kropff M, Ludwig H, et al. Treatment- related peripheral neuropathy in multiple myeloma. The challenge continues. Lancet Oncol. 2010;11:1086–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Lipson EJ, Huff CA, Holanda DG, McDevitt MA, Fine DM. Lenalidomide-induced acute interstitial nephritis. Oncologist. 2010;15:961–4.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    San Miguel JF, Weisel KC, Moreau P, et al. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013;14:1055–01066.CrossRefGoogle Scholar
  11. 11.
    Vickrey E, Allen S, Singhal S. Acyclovir to prevent reactivation of varicella-zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy. Cancer. 2009;115:229–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Ludwig H, Adam Z, Hajek R, Greil R, Tóthová E, Keil F, et al. Light chain induced acute renal failure can be reversed by bortezomib-doxorubicin-dexamethasone in multiple myeloma: results of a phase II study. J Clin Oncol. 2010;28:4635–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Dimopoulos M, Alegre A, Stadtmauer EA, Goldschmidt H, Zonder JA, de Castro CM, et al. The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function. Cancer. 2010;116:3807–14.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Palumbo A, Chanan-Khan A, Weisel K, et al. Daratumumab, bortezomib and dexamethasone for multiple myeloma. N Engl J Med. 2016;375:754–66.CrossRefPubMedGoogle Scholar
  15. 15.
    Dimopoulos MA, Oriol A, Nahi H, et al. Daratumumab, lenalidomide and dexamethasone for multiple myeloma. NEJM. 2016;375:1319–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Lokhorst HM, Plesner T, Lambach JP, et al. Targeting CD38 with daratumumab monotherapy in multiple myeloma. NEJM. 2016;373:1207–19.CrossRefGoogle Scholar
  17. 17.
    Lonial S, Dimopoulos M, Palumbo A, et al. Elotuzumab therapy for relapsed or refractory multiple myeloma. N Engl J Med. 2015;373:621–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Richardson PG, Hungria VTM, Yoon SS, et al. Panobinostat plus bortezomib and dexamethasone in previously treated multiple myeloma: outcomes by prior treatment. Blood. 2016;127:713–21.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Mateos MV, Orlowski RZ, DiCapua Siegel DS, et al. Pembrolizumab in combination with lenalidomide and low-dose dexamethasone for relapsed/refractory multiple myeloma (RRMM): final efficacy and safety analysis. J Clin Oncol. 2016;34(15_suppl):8010.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hematology-OncologyCentre Hospitalier de LuxembourgLuxembourgLuxembourg

Personalised recommendations